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University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet.

OBJECTIVE: The aim of this study was to investigate the association between presenteeism and absenteeism during the previous year and the current levels of exhaustion and impaired work performance in a Swedish university setting.

METHODS: In a study of 3525 employees, an ordinal logistic regression and general linear model was used to examine the association between presenteeism and absenteeism during the previous year and the current exhaustion and impaired work performance, respectively.

RESULTS: Presenteeism, but not absenteeism, during the previous year independently increased the risk of having moderate or severe exhaustion. Presenteeism, absenteeism, and exhaustion remained positively associated with impaired work performance when health status and other confounders had been adjusted for.

CONCLUSIONS: Presenteeism, but not absenteeism, was associated with exhaustion. Both presenteeism and absenteeism were the salient correlates of impaired work performance.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Karolinska institutet.

OBJECTIVE: To examine the associations between SP reported as number of days with SP reported as number of times and to evaluate their responsiveness.

METHODS: The study population (n = 454) consisted of employed individuals, at risk of long-term sickness absence. Correlation analyses were performed to examine associations between the two SP measures and external constructs such as work performance, general health and registered sick leave. Both SP constructs were measured several times to examine responsiveness.

RESULTS: The SP measures are moderately correlated. They moderately correlated with work performance and health status measures. SP reported as number of times seem to be more sensitive than number of days in detecting changes after rehabilitation.

CONCLUSIONS: Numerical or categorical constructs are valid sources of data on SP. However, categorized SP seem to be more responsive.

3. Interventions for common mental disorders in the occupational health service

Axén, Iben

et al.

Karolinska Institutet.

Björk Brämberg, Elisabeth

Sahlgrenska Academy, University of Gothenburg; Karolinska Institutet.

Vaez, Marjan

Karolinska Institutet.

Lundin, Andreas

Karolinska Institutet.

Bergström, Gunnar

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Karolinska Institutet.

Common mental disorders (CMD) are leading causes of decreased workability in Sweden and worldwide. Effective interventions to prevent or treat such disorders are important for public health.

Objective

To synthesize the research literature regarding occupational health service (OHS) interventions targeting prevention or reduction of CMD among employees. The effect on workability (sickness absence, return-to-work and self-reported workability) and on CMD symptoms was evaluated in a narrative analysis.

Data sources

The literature search was performed in four electronic databases in two searches, in 2014 and in 2017.

Eligibility criteria (using PICO)

Population: studies investigating employees at risk or diagnosed with CMD, as well as preventive workplace intervention targeting mental health. Intervention: studies where the recruitment or the intervention was delivered by the OHS or OHS personnel were included. Control: individuals or groups who did not receive the target intervention. Outcome: all types of outcomes concerning sickness absence and psychological health were included.

Study quality was assessed using a Swedish AMSTAR-based checklist, and results from studies with low or medium risk of bias were narratively synthesized based on effect or absence thereof.

Results

Thirty-three studies were included and assessed for risk of bias. Twenty-one studies had low or medium risk of bias. In 18 studies, rehabilitation interventions were evaluated, 11 studies concerned interventions targeting employees at risk for developing CMD and four studies investigated preventive interventions. Work-focused cognitive behavioral therapy and problem-solving skill interventions decreased time to first return-to-work among employees on sick leave for CMD in comparison with treatment-as-usual. However, effect on return to full-time work was not consistent, and these interventions did not consistently improve CMD symptoms. Selective interventions targeting employees at risk of CMD and preventive interventions for employees were heterogeneous, so replication of these studies is necessary to evaluate effect.

Limitations

Other workplace interventions outside the OHS may have been missed by our search. There was considerable heterogeneity in the included studies, and most studies were investigating measures targeting the individual worker. Interventions at the workplace/organizational level were less common.

Conclusions and implication of key findings

Return-to-work and improvement of CMD symptoms are poorly correlated and should be addressed simultaneously in future interventions. Further, interventions for CMD administered through the occupational health service require further study. Rehabilitative and preventive strategies should be evaluated with scientifically robust methods, to examine the effectiveness of such interventions.

4. Effects of time in sitting and standing on pleasantness, acceptability, fatigue and pain when using a sit-stand table: an experiment on overweight and normal-weight subjects

Barbieri, Dechristian

et al.

Department of Physical Therapy, Federal University of São Carlos,.

Brusaca, Luiz Augusto

Department of Physical Therapy, Federal University of São Carlos,.

Mathiassen, Svend Erik

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

5. Neck, trunk, and upper arm posture variation during computer work at a sit-stand table in a real work setting

Barbieri, Dechristian

et al.

Department of Physical Therapy, Federal University of Sao Carlos.

Srinivasan, Divya

Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University.

Mathiassen, Svend Erik

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Background: Computer work is generally associated with constrained postures and sedentary behaviors. Sit-stand tables have been suggested as an effective intervention to promote changes in gross body posture, and thus reduce sitting. However, few studies have addressed to what extent sit-stand table usage affects posture variation in other body regions. The aim of this study was to examine neck, trunk and arm postures among office workers with access to sit-stand tables.

Methods: Twenty-four office workers (16 females, 8 males; mean age 41 (SD9) years) participated. At entry, workers received sit-stand tables, which were then used for two months. Neck and trunk flexion, and right upper arm elevation (RUA) was recorded on three consecutive days, two hours/day, during the last week of table use. Minute-to-minute variability for the three postures during sitting (CWsit) and standing (CWstand) computer work was obtained for each participant. Job variance ratios (JVR) were calculated for the actual work, and for other combinations of CWsit and CWstand by simulation1.

Results: CWsit and CWstand were performed for 72% and 28% of the time spent at the computer. Minute-to-minute variability was larger in CWsit than in CWstand for all three postures, and the difference CWsit-CWstand was largest for RUA [median 1.7 (IQR −0.2–1.7)º], followed by trunk [1.6 (0.9–3.0)º] and neck [0.9 (0.0–3.1)º]. During actual work, JVR was between 1 and 3 for most participants. Simulations suggested that maximum variability would occur at a combination of 40–80% CWsit and 20–60% CWstand.

Conclusion: Neck, trunk and arm posture variation during computer work can be increased by manipulating proportions of time spent sitting and standing at a sit-stand table. The tentative “optimal” proportions reported here could be a benchmark for occupational health professionals.

6. Variation in upper extremity, neck and trunk postures when performing computer work at a sit-stand station

Barbieri, Dechristian

et al.

Department of Physical Therapy, Federal University of São Carlos.

Srinivasan, Divya

Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University.

Mathiassen, Svend Erik

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

The aim of this study was to determine the extent of upper arm, neck and trunk posture variation that can be obtained by combining seated and standing computer work, compared to performing only seated computer work. Posture data were recorded for two hours during each of three days of ordinary work from 24 office workers that had been using a sit-stand station for two months. Periods with sitting and standing computer work were identified using on-site observations, and posture means and minute-to-minute variance were determined for both. Expected minute-to-minute posture variability in different temporal combinations of sitting and standing computer work were determined by simulation, and expressed in terms of a Job Variance Ratio, i.e. the relative increase in variability compared to sitting-only work. For all three postures, mean values differed between sitting and standing computer work, and both showed a notable minute-to-minute variability. For most workers, posture variability was larger when combining sitting and standing than when sitting only, and simulations suggested to introduce more standing than what the worker currently practiced. The results indicate that introducing a sit-stand table could, for most office workers, have a positive effect on upper arm, neck and trunk posture variability.

7. Variation in upper trapezius and wrist extensor EMG among office workers during sit-stand table use in a real work setting

Barbieri, Dechristian

et al.

Department of Physical Therapy, Federal University of Sao Carlos.

Srinivasan, Divya

Department of Industrial and Systems Engineering, Virginia Polytechnic Institute and State University.

Mathiassen, Svend Erik

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Background: Computer work is generally associated with constrained postures and low muscular demands. Sit-stand tables have been suggested as an effective initiative to change working postures during computer work, but the effect of this intervention on muscle activation has rarely been studied. The aim of this study was to document variation in shoulder-arm muscle activation among office workers using sit-stand tables.

Methods: Twenty-four office workers (16 females, 8 males; age 41±9 years) participated. At entry, workers received sit-stand tables and ergonomics information, and then used the table for two months. Muscle activity of right and left upper trapezius and wrist extensors (RUT, LUT, RWE and LWE, respectively) was recorded during three consecutive days (two hours each day) in the last week of sit-stand table usage. Periods of computer work in sitting and standing positions (CWsit and CWstand, respectively) were identified by on-site observation, and synchronized with the EMG recordings. Variability (min-min SD across 1-minute bins, %MVE) was calculated for each EMG recording in CWsit and CWstand.

Results: During the 62 minutes of EMG recorded during computer work, CWsit was performed for 72% and CWstand for 28% of the time. The mean minute-to-minute variability of trapezius EMG was larger (P<0.05) during CWsit (RUT 3.9 (SD between workers 1.6) %MVE; LUT 3.9 (SD 2.3) %MVE) than CWstand (RUT 3.0 (SD 1.5) %MVE; LUT 3.2 (SD 1.9) %MVE). The mean minute-to minute variability in RWE was also larger during CWsit (3.3 (SD 1.4) %MVE) than CWstand (2.9 (SD 1.3) %MVE). For LWE, variability did not differ between CWsit and CWstand.

Conclusion: Sitting and standing computer work was associated with different extents of variation in shoulder-arm muscle activity. Thus, sit-stand tables may introduce beneficial exposure variation into the work of office employees.

8. Effects of relocation to activity-based workplaces on perceived productivity

Bergsten, Eva L.

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Haapakangas, Annu

Faculty of Health and Well-being, Turku University of Applied Sciences, Turku, Finland.

Larsson, Johan

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Jahncke, Helena

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Hallman, David

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

9. Implementing Activity-based Workplaces (ABW) and the importance of participating in process activities

Bergsten, Eva L.

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Wijk, Katarina

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Hallman, David

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

10. Validation of the Copenhagen Psychosocial Questionnaire Version III and Establishment of Benchmarks for Psychosocial Risk Management in Sweden.

Berthelsen, Hanne

et al.

Malmö universitet.

Westerlund, Hugo

Stockholms universitet.

Bergström, Gunnar

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Karolinska institutet.

This study presents the Swedish standard version of the Copenhagen Psychosocial Questionnaire, COPSOQ III, and investigates its reliability and validity at individual and workplace levels with the aim of establishing benchmarks for the psychosocial work environment. Cross-sectional data from (1) a random sample of employees in Sweden aged 25-65 years (N = 2847) and (2) a convenience sample of non-managerial employees at 51 workplaces (N = 1818) were analysed. Internal consistency reliability was evaluated as well as the effects of sex, work sector and blue/white-collar work. Population benchmarks and mean scores for major occupational groups were computed based on weighted data. ICC(1) and ICC(2) estimates were computed to evaluate aggregation to the workplace level and Pearson inter-correlations to evaluate construct validity at individual and aggregated levels. The reliability and scale characteristics were satisfactory, with few exceptions, at both individual and workplace levels. The strength and direction of correlations supported the construct validity of the dimensions and the amount of variance explained by workplace justified aggregation to the workplace level. The present study thus supports the use of COPSOQ III for measurement at the workplace level and presents benchmarks for risk management as well as for research purposes.

11. Occupational and individual determinants of work-life balance among office workers with flexible work arrangements

Bjärntoft, Sofie

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Hallman, David

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Mathiassen, Svend Erik

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Larsson, Johan

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Jahncke, Helena

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Flexible work arrangements permitting workers to work anytime and anywhere are increasingly common. This flexibility can introduce both challenges and opportunities for the organisation, as well as for worker work-life balance (WLB). This cross-sectional study aimed to examine the extent to which occupational factors (organizational, leadership and psychosocial) and individual work-related behaviours (over-commitment, overtime work and boundary management) are associated with WLB, and whether these associations are modified by the perceived level of flexibility at work (i.e., control over when, where, and how to do the work). In total, 2960 full-time office workers with flexible work arrangements at the Swedish Transport Administration participated. Associations were determined using linear regression analyses with adjustment for covariates. The strongest negative associations with WLB were found for over-commitment, quantitative job demands, expectations of availability, and overtime work. Strongest positive associations were found for boundary management, information about organizing work, social support, and relation-oriented leadership. Perceived flexibility was positively associated with WLB, and interacted with several of the examined factors, buffering their negative associations with WLB. Results suggest that WLB can be promoted by organizational initiatives focusing on minimizing excessive job demands, increasing psychosocial resources, supporting boundary management, and enhancing perceived flexibility.

12. Cervico-thoracic and cranio-cervical strength differences between women with and without neck pain and the diagnostic performance of neck-strength tests

Björklund, Martin

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Svedmark, Åsa

Rudolfsson, Thomas

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Djupsjöbacka, Mats

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Background: Cervical strength and stability is often addressed in rehabilitation of people with neck pain. These functions may be associated with emergence and retention of neck pain in cases where the neck strength does not meet daily demands. However, clear empiric support for these notions are lacking, partly due to a scarcity of well controlled dynamometry studies with large samples. First, clarification is needed whether neck strength is in fact reduced in people with neck pain and to resolve the diagnostic performance of neck strength tests.

Purpose: To compare neck muscle strength of women with non-specific long-term neck pain and healthy controls. Also, to assess the diagnostic performance of neck strength tests by assessing their discriminative ability to discern women with and without neck pain.

Methods: The study had a cross-sectional design with data on cervical strength derived from the baseline measurement of a randomized controlled trial (RCT). 80 women with long-term non-specific neck pain (NP) were compared with 40 healthy women (CON). The NP group was a subsample from the RCT selected so that there were no group differences (NP-CON) for body weight and physical activity. Cervical strength assessment included dynamometry of cervico-thoracic extension (CTE) and flexion (CTF) in sitting and cranio-cervical flexion (CCF) in standing, all performed with isometric maximum voluntary contraction (iMVC). Independent samples Mann-Whitney U test and T-test were used to assess group differences for iMVC of the tests. Diagnostic accuracy was further assessed with a receiver operating characteristic (ROC) curve by plotting the true positive rate (sensitivity) as a function of the false positive rate (1 - specificity). The area under the ROC curve (AUC) with 95% confidence interval was used to determine discriminative ability of the tests. The optimal cut-off value to discern NP from CON with corresponding sensitivity and specificity was also determined.

Results: Women with neck pain produced significant lower iMVC in CTE (28%), CTF (26%) and CCF (33%) (all p< 0.001). The ability of CTE, CTF and CCF to discriminate between NP and CON showed moderate accuracy (AUC 0.83, 0.78 and 0.73, respectively). The cut-off value of 165.7 N in CTE had a sensitivity of 0.725 and a specificity of 0.8. The corresponding values for CTF and CCF were 85.8 N (sensitivity 0.8; specificity 0.692) and 4.2 Nm (sensitivity 0.575; specificity 0.9).

Conclusion(s): The neck pain group had less neck muscle strength than controls in all tests. The diagnostic performance of the neck strength tests, judged as discriminative ability to discern neck pain from control participants, were moderate. These results support earlier findings of reduced neck strength in people with neck pain. Also, neck strength tests may have a complementary value in the assessment of neck pain persons.

Implications: The results highlights that impaired neck strength, both in global cervico-thoracic and deep cranio-cervical muscles, is most likely a characteristic of people with long-term neck pain. The study also shows that strength tests could be used with fairly good discriminative precision and may thereby be valuable assessment tools.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.

Objectives To develop predictive models for short-term and long-term clinically important improvement in women with non-specific chronic disabling neck pain during the clinical course of physiotherapy. Design Longitudinal cohort study based on data from a randomised controlled trial evaluating short-term and long-term effects on sensorimotor function over 11 weeks of physiotherapy. Participants and settings Eighty-nine women aged 31-65 years with non-specific chronic disabling neck pain from Gavle, Sweden. Measures The outcome, clinically important improvement, was measured with the Patient Global Impression of Change Scale (PGICS) and the Neck Disability Index (NDI), assessed by self-administered questionnaires at 3, 9 and 15 months from the start of the interventions (baseline). Twelve baseline prognostic factors were considered in the analyses. The predictive models were built using random-effects logistic regression. The predictive ability of the models was measured by the area under the receiver operating characteristic curve (AUC). Internal validity was assessed with cross-validation using the bootstrap resampling technique. Results Factors included in the final PGICS model were neck disability and age, and in the NDI model, neck disability, depression and catastrophising. In both models, the odds for short-term and long-term improvement increased with higher baseline neck disability, while the odds decreased with increasing age (PGICS model), and with increasing level of depression (NDI model). In the NDI model, higher baseline levels of catastrophising indicated increased odds for short-term improvement and decreased odds for long-term improvement. Both models showed acceptable predictive validity with an AUC of 0.64 (95% CI 0.55 to 0.73) and 0.67 (95% CI 0.59 to 0.75), respectively. Conclusion Age, neck disability and psychological factors seem to be important predictors of improvement, and may inform clinical decisions about physiotherapy in women with chronic neck pain. Before using the developed predictive models in clinical practice, however, they should be validated in other populations and tested in clinical settings.

14. Health and work environment among female and male Swedish elementary school teachers - A cross-sectional study

Boström, Maria

et al.

Karolinska institutet.

Björklund, Christina

Karolinska institutet.

Bergström, Gunnar

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Karolinska institutet.

BACKGROUND AND OBJECTIVES: Changes in teachers' work situation in Sweden since the 1990s may have contributed to an increase in common mental disorders (CMDs) and burnout. However, there is a lack of research in this field. The aim was to describe how Swedish elementary school teachers experience their health, organizational and social work environment, and the psychosocial safety climate at the workplace, and especially differences and similarities between female and male teachers.

MATERIALS AND METHODS: Data were collected with the COPSOQ, OLBI, UWES and PSC-12 from 478 elementary teachers, 81.0% of them women, from twenty schools. The response rate was 96.4%.

RESULTS: Teachers reported relatively good general health but experienced high stress, high work pace and emotional demands, low influence at work and a poor psychosocial safety climate. These factors were especially prominent among female teachers. Both women and men experienced good development possibilities and high work engagement.

CONCLUSIONS: The results of this study can help us to develop a more sustainable work environment for female and male teachers. A more sustainable work environment might attract more people to the profession and incentivize existing teachers to remain in the profession.

The aim was to investigate if the method of normalizing surface electromyography (sEMG) can change results on sex differences in the muscular activation of the shoulder girdle muscles during a simulated work task. sEMG was recorded in 36 asymptomatic participants (17 females, 19 males) from four parts of trapezius and from serratus anterior muscles during a simulated work task. Four normalization methods, one involving maximal voluntary contractions (MVCs) and three involving submaximal voluntary contractions were applied. Sex differences in absolute and normalized amplitude of sEMG were analyzed. The normalization method had a significant influence on the observed sex differences. Females only showed higher sEMG amplitude than males when the sEMGs were normalized to MVC and to a submaximal contraction based on 20% of MVC for the upper trapezius (acromial fibers). Researchers and practitioners should be aware of the impact of the sEMG normalization method in sex differences investigation.

Department of Public Health and Primary Care, Ghent University, Belgium.

Hallman, David

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

The aim was to describe occupational physical activity (OPA) and examine the role of psychosocial job resources among blue-collar workers. In a sample of 198 workers (57% male; mean age 44.9 (SD 9.9) year) from 7 companies in Denmark, two accelerometers (Actigraph) were placed on the thigh and trunk during 1-5 consecutive days, to determine working time spent standing, walking, on feet and in activity of moderate to vigorous intensity level (MVPA). The level of influence and social support at work were assessed by questionnaire. The exposure to OPA significantly varied by particular job type, especially in male predominant occupations. Overall, psychosocial job resources did not affect the exposure to OPA. These findings suggest that workplace interventions aiming to prevent adverse outcomes of OPA among blue-collars workers ought to focus on task redesign and target work organizational factors related to specific job type.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Objective: Emerging evidence suggests that excessive sitting has negative health effects. However, this evidence largely relies on research using self-reported sitting time, which is known to be biased. To correct this bias, we aimed at developing a calibration model estimating "true" sitting from self-reported sitting.

Methods: Occupational sitting time was estimated by self-reports (the International Physical Activity Questionnaire) and objective measurements (thigh-worn accelerometer) among 99 Swedish office workers at a governmental agency, at baseline and 3 and 12 months afterwards. Following compositional data analysis procedures, both sitting estimates were transformed into isometric log-ratios (ILR). This effectively addresses that times spent in various activities are inherently dependent and can be presented as values of only 0−100%. Linear regression was used to develop a simple calibration model estimating objectively measured "true" sitting ILR (dependent variable) from self-reported sitting ILR (independent variable). Additional self-reported variables were then added to construct a full calibration model. Performance of the models was assessed by root-mean-square (RMS) differences between estimated and objectively measured values. Models developed on baseline data were validated using the follow-up datasets.

Conclusions: Calibration adjusting for errors in self-reported sitting led to substantially more correct estimates of "true" sitting than uncalibrated self-reports. Validation indicated that model performance would change somewhat in new datasets and that full models perform no better than simple models, but calibration remained effective.

Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.

van der Beek, Allard J.

Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.

Jackson, Jennie

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Mathiassen, Svend Erik

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

The aim of this study was to develop and evaluate calibration models to predict objectively measured time spent sitting, standing and walking during office work from self-reported time-use compositions using a compositional data analysis (CoDA) approach. Ninety-nine office workers (49 women) at the Swedish Transport Administration participated in an intervention study on relocation to activity-based offices. At baseline and at a 3-months follow-up, physical behaviours (sitting, standing and walking) at work were assessed for five days using a thigh-mounted accelerometer (Actigraph) and by self-report (IPAQ). The time-use composition of the three behaviours was expressed in terms of isometric log-ratios (ILR). Calibration models predicting accelerometry-based time-use from self-reported compositions were constructed using linear regression on baseline data, and then validated using follow-up data. The accelerometer data showed that, on average, workers spent 69.9% of their day sitting, 23.7% standing, and 6.4% walking. The corresponding percentages for self-reports were 71.7%, 21.6%, and 7.4%, respectively. Non-calibrated self-reports were biased: the RMS errors obtained from the ILRs expressing sitting, standing and walking were 0.73, 1.09 and 1.05, respectively. Calibration models reduced these errors by 45% (sitting), 56% (standing), and 76% (walking). Validation of the calibration models using follow-up data from the same workers showed calibration remained equally effective; RMS errors were reduced by 55% (sitting), 58% (standing), and 75% (walking). In conclusion, calibration models for compositional time-use data were effective in reducing bias in self-reported physical behaviours at work, and the models remained effective when used on new data from the same workers. Calibrated self-reports may represent a cost-effective method for obtaining physical behaviour data with a satisfying accuracy in large-scale cohort and intervention studies.

19. Inequity in physiotherapeutic interventions for children with Cerebral Palsy in Sweden - a national registry study.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.

AIM: The aim of this study was to investigate the distribution of physiotherapeutic interventions for children with Cerebral Palsy in Sweden from an equity perspective, considering sex, country of birth and geographical region.

METHOD: This national cross-sectional registry study includes children with Cerebral Palsy aged 0-18 years who participated in 2015 in the Swedish national quality registry, the Cerebral Palsy follow-up program, CPUP. Comparisons and associations between physiotherapeutic interventions and sex, country of birth and geographical regions were conducted using Chi2 and logistic regression analysis, controlling for cognitive level, level of motor function, age group and dominating symptom.

RESULTS: Of the 2855 participants, 2201 (79%) had received physiotherapy. Children born in Sweden had 1.60 times higher odds (95% CI 1.10-2.33) of receiving physiotherapy compared with children born in foreign countries. Distribution of physiotherapeutic interventions differed significantly between geographical regions. No associations between sex and physiotherapeutic interventions were observed.

CONCLUSION: The results of this study indicate inequity in care in Sweden towards children with Cerebral Palsy born in other counties. Further, physiotherapeutic interventions were not equally distributed in different.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

The present study aimed to identify whether or not an increase in ciliary-muscle contraction force, when the eye-lens is adjusted for viewing at a near distance, result in an increase in trapezius muscle activity, while performing a natural work task. Twelve participants, ranging in age from 21 to 32 years, performed a computer-mouse work task during free gaze conditions. A moving visual target was tracked with a computer mouse on a screen placed at two different distances from the eyes, 25 cm and 50 cm. Tracking performance, eye accommodation, and bilateral trapezius muscle activity were measured continuously. Ciliary-muscle contraction force was computed according to a formula which takes into account the age-dependent, non-linear relationship between contraction force of the ciliary muscle and the produced level of eye accommodation. Generalized Estimating Equations analyses were performed. On the dominant hand side and for the nearest screen distance, there was a significant effect of ciliary-muscle contraction force on the trapezius muscle activity (p<0.001). No other effects were significant (p>0.05). The results support the hypothesis that high visual demands, during computer mouse work, increase ciliary muscle contraction force and contribute to a raise of the sustained level of trapezius muscle activity. The current study specifically clarifies the validity of the relationship between ciliary-muscle contraction force and trapezius muscle activity and demonstrates that this relationship is not due to a general personal trait. We conclude that a high level of ciliary muscle contraction force can contribute to a development of musculoskeletal complaints in the neck-shoulder area.

University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.

Strömberg, Annika

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Hagerman, Heidi

University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science.

BACKGROUND: The importance of staff working life for staff well-being has been demonstrated in several studies; less research has focused on staff working life and older persons' satisfaction with care.

PURPOSE: The study aim was to study relationships between 1) staff assessments of their structural conditions/empowerment in elderly care, psychological empowerment, and job satisfaction and (2) older persons' satisfaction with care.

METHODS: A multilevel, cross-sectional, and correlational design was applied using questionnaire data on working life (1021 staff members) and unit-level data (40 elderly care units) on older persons' satisfaction with care.

RESULTS: Statistically significant relationships were found between all 3 working life variables and older persons' satisfaction with care. Furthermore, the results revealed an indirect/mediating effect of job satisfaction between structural empowerment and satisfaction with care, but not for psychological empowerment.

National Research Centre for the Working Environment, Copenhagen, Denmark.

van der Beek, Allard

Department of Public and Occupational Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Huysmans, Maaike

Department of Public and Occupational Health, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Mathiassen, Svend Erik

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Straker, Leon

School of Physiotherapy and Curtin Health Innovation Research Institute, Curtin University, Perth, Australia.

Results: Twenty studies (representing 11 data sets), all from developed world economies, met inclusion criteria. The mean quality score for selected studies was 9.5 (SD 0.8) out of a maximum of 12. Data were analyzed using a range of analytical techniques (eg, accelerometer counts or pattern recognition algorithms). “Blue-collar” workers were more sedentary and less active during nonwork compared with work time (eg, sitting 5.7 vs 3.2 h/d; moderate to vigorous PA 0.5 vs 0.7 h/d). Drivers were the most sedentary (work time 5.1 h/d; nonwork time 8.2 h/d).

Conclusions: High levels of sedentary time and insufficient PA to offset risk are health issues for “blue-collar” workers. To better inform interventions, research groups need to adopt common measurement and reporting methodologies.

National Research Centre for the Working Environment, Copenhagen, Denmark.

van der Beek, Allard

VU University Medical Centre, Amsterdam, The Netherlands.

Huysmans, Maaike

VU University Medical Centre, Amsterdam, The Netherlands.

Mathiassen, Svend Erik

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

National Research Centre for the Working Environment, Copenhagen, Denmark.

Hallman, David

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Dumuid, Dorothea

Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, SA, Australia.

Vij, Akshay

Institute for Choice, University of South Australia, Adelaide, Australia.

Lund Rasmussen, Charlotte

National Research Centre for the Working Environment, Copenhagen, Denmark; Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

Birk Jørgensen, Marie

Department of Forensic Science, University of Copenhagen, Copenhagen, Denmark.

Holtermann, Andreas

National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.

An element of obesity prevention is increasing total physical activity energy expenditure. However, this approach does not incorporate the balance of various movement behaviors—physical activity, sedentary behaviors and sleep - across domains of the day. We aimed to identify time-use profiles over work and leisure, termed ‘movement behavior profiles’ and to investigate their association with obesity.

Subjects/methods

Eight-hundred-and-seven workers completed (a) thigh accelerometry and diaries to determine their 24-h composition of behaviors (sedentary and standing, light physical activity and moderate-to-vigorous physical activity at work and leisure, and time in bed) and (b) obesity measurements. Movement behavior profiles were determined using latent profile analyses of isometric log-ratios of the 24-h composition, and labeled according to animal movement behavior traits. Linear models were applied to determine the association between profiles and obesity.

Results

Four profiles were identified, labeled as “Chimpanzees” (n = 226), “Lions” (n = 179), “Ants” (n = 244), and “Koalas” (n = 158). “Chimpanzees” work time was evenly distributed between behaviors while their leisure time was predominantly active. Compared to Chimpanzees, “Lions” were more active at work and sedentary during leisure and spent more time in bed; “Ants” were more active at work and during leisure; “Koalas” were more sedentary at work and leisure and spent similar time in bed. With “Chimpanzees” as reference, “Lions” had least favorable obesity indicators: +2.0 (95% confidence interval [CI] 0.6, 3.4) %body fat, +4.3 cm (1.4, 7.3) waist circumference and +1.0 (2.0, 0.0) Body Mass Index (BMI), followed by “Koalas” +2.0 (0.4, 3.7) %body fat, +3.1 cm (0.1, 6.0) waist circumference, and +0.8 (−0.30, 1.94) BMI. No significant differences were found between “Chimpanzees” and “Ants”.

Conclusions

Movement behavior profiles across work and leisure time-use compositions are associated with obesity. Achieving adequate balance between work and leisure movement behaviors should be further investigated as a potential obesity prevention strategy.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Dumuid, Dorothea

Alliance for Research in Exercise, Nutrition and Activity (ARENA), School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.

Vij, Akshay

Institute for Choice, University of South Australia, North Sydney, Australia.

Introduction Obtaining a balance between exercise and recovery is an established approach in Exercise Science to improve aerobic capacity. However, it is unknown how different 24-h time-use profiles depicting a balance between physical behaviors (i.e. physical activities, sedentary behavior and sleep) across main domains of the day are associated with aerobic capacity. We aimed to identify such 'physical-behavior (PB) profiles' and to investigate their association with aerobic capacity. Methods Workers (n=807) participated in thigh-accelerometry to determine 24-h time-use composition of physical activity, sedentary and standing during work and leisure, as well as time in bed. Åstrand submaximal cycle ergometer test was used to estimate aerobic capacity. The PB profiles were determined using latent profile analysis of isometric log-ratios representing the 24-hour composition. Linear models were applied to determine the cross-sectional association between physical-behavior profiles and aerobic capacity. Results Four PB profiles were identified that were labeled based on animal traits; Chimpanzees (n=226), Lions (n=179), Ants (n=244), and Koalas (n=158). Compared to Chimpanzees (at work, in mins; sedentary=197, standing=145, physical activity=117; and at leisure in mins; physical activity=114, standing=121, time in bed= 440); Lions were more active at work, sedentary at leisure and spent more time in bed; Ants had more physical activity at work and similar physical activity and time in bed at leisure; Koalas were more sedentary at work and leisure and spent more time in bed. Compared to Chimpanzees, Koalas had lower aerobic capacity (mlO2/kg/min): -3.7 (95%CI -6.0,-1.5), followed by Lions -3.6 (-5.5,-1.7) and Ants -1.8 (-3.7,- 0.1). Conclusions Physical-behavior profiles based on 24-h time-use composition are associated with aerobic capacity. Obtaining a balance between physical behaviors at work and leisure may be a promising approach for improving aerobic capacity.

26. Time-based data in occupational studies - the whys, the hows and some remaining challenges in Compositional Data Analysis (CoDA)

Gupta, Nidhi

et al.

National Research Centre for the Working Environment, Copenhagen .

Lund Rasmussen, Charlotte

National Research Centre for the Working Environment, Copenhagen .

Holtermann, Andreas

National Research Centre for the Working Environment, Copenhagen .

Mathiassen, Svend Erik

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Data on the use of time in different exposures, behaviors and work tasks are common in occupational research. Such data are most often expressed in hours, minutes, or percentage of work time. Thus, they are constrained or “compositional”, in that they add up to a finite sum (e.g. 8 hours of work, or 100% work time). Due to their properties, compositional data need to be processed and analyzed using a set of specifically adapted methods called compositional data analysis (CoDA). CoDA has become an established framework to handle compositional data in various scientific fields such as nutritional epidemiology, geology and chemistry, but has only recently gained attention in public and occupational health sciences. In this paper, we introduce the reader to CoDA by explaining why CoDA should be used when dealing with compositional time-use data, showing how to perform CoDA, including a worked example, and pointing at some remaining challenges in CoDA. The paper concludes by emphasizing that CoDA in occupational research is still in its infancy, and stresses the need for further development and experience in the use of CoDA for time-based occupational exposures. We hope that the paper will encourage researchers to adopt and apply CoDA in studies of work exposures and health.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Institute of Environmental Medicine, Unit of Intervention and Implementation Research for Worker Health, Karolinska Institutet, Stockholm, Sweden.

OBJECTIVES: The aim of the present study was to examine how presenteeism affects the risk of future disability pension among nursing professionals and care assistants (assistant nurses, hospital ward assistants, home-based personal care workers, and child care assistants). A specific objective was to compare health and social care employees with all other occupations.

METHODS: The study was based on a representative sample of working women and men (n = 43 682) aged 16-64 years, who had been interviewed between 2001 and 2013 for the Swedish Work Environment Survey conducted every second year since 1989. Information on disability pension was obtained from the Social Insurance Agency's database (2002-2014). The studied predictors were related to disability pension using Cox's proportional hazard regression with hazard ratios (HR) and 95% confidence interval (CI) and selected confounders were controlled for. The follow-up period was 6.7 years (SD 4.2).

RESULTS: Health and social care employees with frequent presenteeism showed a particularly elevated risk of future disability pension after adjusting for sex, sociodemographic variables, physical and psychosocial working conditions, and self-rated health symptoms. In the amalgamated occupational group of nursing professionals and care assistants, the impact on disability pension of having engaged in presenteeism four times or more during the prior year remained significant (HR = 3.72, 95% CI = 2.43-5.68).

CONCLUSIONS: The study suggests that frequent presenteeism contributes to an increased risk of disability pension among nursing professionals and care assistants as well as among all other occupations.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Karolinska Institutet.

Presenteeism, attending work while ill, has been examined in different contexts in the last few decades. The aim was to examine whether poor psychosocial working conditions and perceived work ability are associated with increased odds ratios for presenteeism, focusing on nursing professionals and care assistants. A cross-sectional population-based study was conducted. The selected individuals were extracted from representative samples of employees, aged 16&ndash;64, who participated in the Swedish Work Environment Surveys between 2001 and 2013 (n = 45,098). Three dimensions of psychosocial working conditions were measured: job demands, job control, and job support. Presenteeism and perceived work ability was measured. Using multiple logistic regression analyses, odds ratios for presenteeism with 95% confidence intervals (CI) were estimated. While nurses (n = 1716) showed the same presenteeism level as all the other occupation groups (n = 37,125), it was more common among care assistants (n = 6257). The odds ratio for presenteeism among those with high job demands (OR = 2.37, 95% CI 2.21&ndash;2.53), were higher among women than among men. For nursing professionals and care assistants, the odds ratios for presenteeism were highest among those with the lowest work ability level. The problems of presenteeism and low work ability among many health and care workers may be lessened by a reduction in psychosocial demands.

29. The effects of moving into an activity-based office on communication, social relations and work demands – A controlled intervention with repeated follow-up

Haapakangas, Annu

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Hallman, David

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Mathiassen, Svend Erik

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Jahncke, Helena

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

When organizations adopt activity-based workplaces (ABWs), improved interaction is a common goal. Yet, few controlled longitudinal studies have been conducted on the effects of ABWs on interaction, social relations and work demands. The aim of this natural intervention study was to investigate the effects of moving into an ABW on satisfaction with communication, on social relations (i.e., social support and social community) and on work demands (i.e., quantitative demands, emotional demands and work pace) 3 months and 12 months after the relocation. The study included four offices which relocated into an ABW and one control office that did not. Questionnaire data from 408 respondents were analyzed with linear mixed models. Satisfaction with communication and the sense of belonging to a community had decreased 3 and 12 months after the relocation. Work pace was not affected while small, mostly short-term, negative effects on social support, quantitative demands and emotional demands were only observed among employees who had moved to ABWs from private offices. Differences between office sites were also observed. The results suggest that, to avoid negative outcomes, organizations moving to ABWs should focus on solving difficulties in locating colleagues at the office and on supporting particularly workers from private offices in adopting activity-based working.

30. Application of a sense of coherence-based leadership for productivity and health at Scania

Halling, Bengt

et al.

University of Gävle, Faculty of Engineering and Sustainable Development, Department of Industrial Management, Industrial Design and Mechanical Engineering, Industrial Management. University of Gävle, Center for Logistics and Innovative Production. Division of Ergonomics, Royal Institute of Technology, KTH.

Lyckström, Martin

Scania CV AB, Södertälje, Sweden.

Wijk, Katarina

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Centre for Research and Development, Region Gävleborg, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden .

The purpose was to explore if sense of coherence (SOC) theory can be used in human factors ergonomics (HFE) practice as a leadership approach to decrease the rate of sick leave and rehabilitation cases and increase work attendance among assembly personnel without impeding productivity. Via three studies carried out at the Swedish truck manufacturer Scania, we investigated the company's key performance indicators and documented meetings with managers during the intervention. The results show that SOC can be used in HFE practice and that productivity, quality and attendance at work increased, while rehabilitation cases decreased. Our conclusion is that a health promotion approach among managers is essential in a lean organisation that aims to reduce waste in the company and optimise human capability and thereby productivity. SOC theory can support the creation of workplaces that are high performing and healthy, starting with concerns for the people creating the output.

31. Sick leave due to musculoskeletal pain : determinants of distinct trajectories over 1 year

Hallman, David

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Holtermann, Andreas

National Research Centre for the Working Environment, Copenhagen, Denmark.

Björklund, Martin

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.

Gupta, Nidhi

National Research Centre for the Working Environment, Copenhagen, Denmark.

Nørregaard Rasmussen, Charlotte D.

National Research Centre for the Working Environment, Copenhagen, Denmark.

This study aimed to identify sub-groups of workers with different trajectories of sick leave due to musculoskeletalpain over 1 year, and to investigate the extent to which the identified trajectories are associated with personal, occupational,lifestyle, and pain-related factors at baseline.

Methods

Data on 981 blue- and white-collar workers were analyzed in the DPHACTO cohort (2012–2014). The numberof days on sick leave due to pain was reported using text messages at 4-week intervals across 1 year. Latent class growthanalysis was used to distinguish sub-groups with different trajectories of sick leave. A web-based questionnaire at baselinewas used to assess personal, occupational (physical and psychosocial), lifestyle, and pain-related factors. Multinomial regressionmodels were constructed to determine associations between baseline factors and trajectories of sick leave (referencingno sick leave), with adjustment for potential confounders.

Results

Four distinct sub-groups were identified, with trajectories of sick leave due to pain ranging from no sick leave(prevalence 76%; average 0.5 days/year) to some days and increasing sick leave due to pain over 1 year (2%; 89 days/year).The increasing trajectory of sick leave was associated with higher perceived physical exertion, more time in manual work,less social community and influence at work, less leisure-time physical activity, smoking, and more severe symptoms (e.g.,multisite pain, low back pain intensity, and pain interference).

Conclusions

We identified four distinct trajectories of sick leave due to musculoskeletal pain. The sub-group with increasingsick leave due to pain was associated with several modifiable physical and psychosocial factors at work and outside work,which may have implications for prevention.

32. Are trajectories of neck-shoulder pain associated with sick leave and work ability in workers? A 1-year prospective study

Hallman, David

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Holtermann, Andreas

National Research Centre for the Working Environment, Copenhagen, Denmark.

Dencker-Larsen, Sofie

National Research Centre for the Working Environment, Copenhagen, Denmark.

Birk Jorgensen, Marie

National Research Centre for the Working Environment, Copenhagen, Denmark.

Nørregaard Rasmussen, Charlotte

National Research Centre for the Working Environment, Copenhagen, Denmark.

ObjectivesThe study aimed to determine the extent to which latent trajectories of neck–shoulder pain (NSP) are associated with self-reported sick leave and work ability based on frequent repeated measures over 1 year in an occupational population.

MethodsThis longitudinal study included 748 Danish workers (blue-collar, n=620; white collar, n=128). A questionnaire was administered to collect data on personal and occupational factors at baseline. Text messages were used for repeated measurements of NSP intensity (scale 0–10) over 1 year (14 waves in total). Simultaneously, selfreported sick leave (days/month) due to pain was assessed at 4-week intervals, while work ability (scale 0–10) was assessed using a single item (work ability index) at 12-week intervals over the year. Trajectories of NSP, distinguished by latent class growth analysis, were usedas predictors of sick leave and work ability in generalised estimation equations with multiple adjustments.

ConclusionSevere persistent NSP was associatedwith sick leave and poor work ability over 1 year amongworkers. Preventive strategies aiming at reducing severepersistent NSP among working populations are needed.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Mathiassen, Svend Erik

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

We developed and evaluated calibration models predicting objectively measured sitting, standing and walking time from self-reported data using a compositional data analysis (CoDA) approach. A total of 98 office workers (48 women) at the Swedish Transport Administration participated. At baseline and three-months follow-up, time spent sitting, standing and walking at work was assessed for five working days using a thigh-worn accelerometer (Actigraph), as well as by self-report (IPAQ). Individual compositions of time spent in the three behaviors were expressed by isometric log-ratios (ILR). Calibration models predicting objectively measured ILRs from self-reported ILRs were constructed using baseline data, and then validated using follow-up data. Un-calibrated self-reports were inaccurate; root-mean-square (RMS) errors of ILRs for sitting, standing and walking were 1.21, 1.24 and 1.03, respectively. Calibration reduced these errors to 36% (sitting), 40% (standing), and 24% (walking) of those prior to calibration. Calibration models remained effective for follow-up data, reducing RMS errors to 33% (sitting), 51% (standing), and 31% (walking). Thus, compositional calibration models were effective in reducing errors in self-reported physical behaviors during office work. Calibration of self-reports may present a cost-e_ective method for obtaining physical behavior data with satisfying accuracy in large-scale cohort and intervention studies.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Niklas, Krause

Departments of Epidemiology and Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA.

Excessive sitting and standing are proposed risk factors for cardiovascular diseases (CVDs), possibly due to autonomic imbalance. This study examines the association of objectively measured sitting and standing with nocturnal autonomic cardiac modulation. The cross-sectional study examined 490 blue-collar workers in three Danish occupational sectors. Sitting and standing during work and leisure were assessed during 1–5 days using accelerometers. Heart rate (HR) and heart rate variability (HRV) were obtained during nocturnal sleep as markers of resting autonomic modulation. The associations of sitting and standing still (h/day) with HR and HRV were assessed with linear regression models, adjusted for age, gender, body mass index, smoking, and physical activity. More sitting time during leisure was associated with elevated HR (p = 0.02), and showed a trend towards reduced HRV. More standing time at work was associated with lower HR (p = 0.02), and with increased parasympathetic indices of HRV (root mean squared successive differences of R-R intervals p = 0.05; high-frequency power p = 0.07). These findings, while cross-sectional and restricted to blue-collar workers, suggest that sitting at leisure is detrimental to autonomic cardiac modulation, but standing at work is beneficial. However, the small effect size is likely insufficient to mitigate the previously shown detrimental effects of prolonged standing on CVD.

35. Time-use composition of physical behaviors at work and sick-leave trajectories due to musculoskeletal pain

Hallman, David

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

There is limited knowledge on the influence of physical behaviors at work such as sitting, standing, low- (LIPA) and moderate-to-vigorous physical activity (MVPA) on sick leave due to pain. Studies addressing this relationship using valid objective measures of physical behaviors are scarce. The aim was to determine the prospective association between time-use compositions of physical behavior at work with sick leave trajectories due to musculoskeletal pain.

Methods

Data on 981 workers were analyzed in the DPHACTO cohort (2012-2014). Physical behaviors at work were assessed objectively at baseline using accelerometers, and the resulting time-line of exposure at work was classified as sitting, standing, low- (LIPA) and moderate-to-vigorous physical activity (MVPA). The number of days on sick leave due to musculoskeletal pain was reported using text messages at 4-week intervals across 1 year (14 waves in total). Latent class growth analysis was used to distinguish sub-groups with different trajectories of sick leave. Associations between time-use in physical behaviors and sick leave trajectories were determined using multinomial regression analysis with adjustment for age and gender. Compositional data analysis was used to account for the co-dependency of different behaviors.

Results

We identified four distinct trajectories of sick leave due to pain over one year as follows: no days (prevalence 76%), few days-increasing (19%), some days-decreasing (3%), and some days-increasing (2%). Spending more time in sitting relative to the other behaviors was associated with a reduced likelihood of few days-increasing sick leave (class 2 p<0.001), while time in LIPA was associated with an increased likelihood of some days-increasing sick leave (class 4 p=0.001).

Conclusion

We found that the time-use composition of physical behaviors at work was associated with sick leave trajectories due to pain over 1 year. Reducing time in occupational physical activities in favor of sitting may be useful for preventing sick leave due to musculoskeletal pain.

36. Telecommuting in academia – associations with health and well-being among staff

Heiden, Marina

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Widar, Linda

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Wiitavaara, Birgitta

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Boman, Eva

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Psychology.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Zetterberg, Camilla

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Lindberg, Per

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

To describe the development of a computer-based risk assessment method for visual ergonomics, and assess its face validity, content validity, and internal consistency.

Methods

The risk assessment method contained a questionnaire for the worker, an evaluation form for the evaluator, a section of follow-up questions based on the worker's responses, and a section for recommended changes, including an overall risk assessment with respect to daylight, lighting, illuminance, glare, flicker, work space, work object and work postures, respectively. Forty-eight trained evaluators used the method to perform 224 workplace evaluations. Content validity of the method was assessed by the completeness and distribution of responses, and internal consistency was assessed by Cronbach's alpha, Spearman's rank correlation between items and indices, and exploratory factor analysis.

Results

The proportion of missing values in items was generally low (questionnaire: 0–2.3%; evaluation form: 1.4–4.1%). In the questionnaire, items about double vision, migraine and corrective lenses had limited information content. Cronbach's alpha and item-index correlations for the indices frequency of eyestrain, intensity of eyestrain, visual symptoms, lighting conditions, frequency of musculoskeletal discomfort and intensity of musculoskeletal discomfort were satisfactory. Based on the factor analysis, suggestions for improving some of the indices were made.

Conclusion

Our findings suggest that this computer-based method is a valid instrument for assessing risks in the visual work environment. By incorporating subjective ratings by the worker as well as objective measurements of the work environment, it provides a good basis for recommendations with respect to daylight, lighting, work surfaces/material, and work object.

Relevance to industry

Visual environment factors, such as glare, can cause eyestrain, headache and musculoskeletal discomfort. This method satisfies the need of a valid tool for determining risks associated with the visual work environment. It contains both worker's ratings and objective measurements, and is designed to be used in different types of work.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Zetterberg, Camilla

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Mathiassen, Svend Erik

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

The aim of this study was to assess postures andmovements of the trunk and upper arm during paper mill work, and to determinethe extent to which they differ depending on method of assessment. For each oftwenty-eight paper mill workers, postures and movements were assessed duringthree full shifts using inclinometer registration and observation from video. Summary metrics for each shift, e.g.,10th, 50th, and 90th posture percentile, were averagedacross shifts and across workers. In addition, the standard deviation between workers,and the standard deviation between shifts within worker were computed. The resultsshowed that trunk and arm postures during paper mill work were similar to otheroccupations involving manual materials handling, but the velocity of armmovements were lower. While postures determined by inclinometry and observationwere similar on a group level, substantial differences were found betweenresults obtained by the two methods for individual workers, particularly for extremepostures. Thus, measurements by either method on individuals or small groupsshould be interpreted with caution.

Objectives The aim of this study was to examine the association between long-term sickness absence (LTSA) due to mental disorders and musculoskeletal disorders and all-cause disability pension (DP) among blue- and white-collar workers. A secondary objective was to examine the influence of familial factors on the associations. Methods This was a prospective twin cohort study of 42 984 individuals (21-64 years at baseline), 3017 of whom had a new LTSA spell (>14 days) due to mental or musculoskeletal disorders in 2005-2006. Average follow-up time was 5.4 years. Survey data on occupational class and register data on LTSA and DP were used. Cox proportional hazards regression was applied to calculate hazards ratios (HR) with 95% confidence intervals (CI). Results During follow-up, 989 participants went on disability. LTSA due to mental disorders and musculoskeletal disorders led to similar HR for DP among both white- and blue-collar workers when compared to white-collar workers not on LTSA (reference group). LTSA >= 6 months due to musculoskeletal disorders was associated with a higher risk of DP for white-collar (HR 31.50, 95% CI 20.45-48.52) than blue-collar (HR 17.64, 95% CI 13.08-23.78) workers when compared to the reference group. HR were lower in the discordant twin pair models for LTSA due to mental disorders than in the whole cohort. Conclusions White-collar workers on LTSA due to musculoskeletal disorders are especially vulnerable to all-cause DP. This pattern was not present for LTSA due to mental disorders. Familial factors seem to influence the association between LTSA due to mental disorders and all-cause DP.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Unit of Intervention and Implementation Research for Worker Health, The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.

Background: Sickness absence (SA) is becoming a major economic problem in many countries. Our aim was to investigate whether type of employment, including temporary employment or part-time employment, is associated with SA while controlling for familial factors (genetic and shared environment). Differences between men and women and across employment sectors were explored.

Methods: This is a prospective twin study based on 21 105 twins born in Sweden 1959-85. The participants completed a survey in 2005 with follow-up of SA (≥15 days), using register data, until end of 2013. The data were analyzed with logistic regression, with results presented as odds ratios (OR) with 95% confidence intervals (CI).

Conclusions: Employment type is associated with SA, with temporary employment involving a higher risk compared to permanent full-time employment while both part-time employment and self-employment involved a lower risk. The associations vary between women and men and across sectors.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Straker, Leon

School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.

In spite of preventive efforts, organizations and employees face several challenges related to working life and occupational health, such as a substantial prevalence of musculoskeletal disorders, social inequality in health and physical capacity, multi-morbidity, an obesity epidemic and an aging workforce. We argue that a new approach for occupational ergonomics and health is required, going beyond prevention of harm caused by work. We propose the ´Goldilocks Principle´ as a new approach of how productive work can be designed to literally promote health and physical capacity.

Methods

Physical (in)activity profoundly influences health and physical capacity, with effects depending on the extent and temporal structure of the (in)activity. Like the porridge, chair and bed that needed to be ‘just right’ for Goldilocks in the fairy-tale of ´The Three Bears´, physical activity during productive work needs to be ‘just right’ for promoting rather than deteriorating health and capacity. In many jobs, physical activity is, however, either ’too much/high/frequent’ or ’too little/low/infrequent’ to give positive biomechanical and cardiometabolic stimuli.

Results

The paper presents the rationale, concept, development, application and prospects of the Goldilocks Principle for how productive work can be designed to promote health and physical capacity.

Conclusions

We envision a great potential to promote health and physical capacity by designing productive work according to the Goldilocks Principle, thus leading to benefits with respect to the current challenges related to working life and occupational health for society, organizations and employees.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Department of Public and Occupational Health, Vrije Universiteit Amsterdam; Research Center for Insurance Medicine, AMC-UMCG-UWV-VUmc, Amsterdam, The Netherlands.

Srinivasan, Divya

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Virginia Polytechnic Institute and State University, Blacksburg, USA.

Mathiassen, Svend Erik

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

INTRODUCTION: Sit-stand workstations are a popular intervention to reduce sedentary behavior (SB) in office settings. However, the extent and distribution of SB in office workers long-term accustomed to using sit-stand workstations as a natural part of their work environment are largely unknown. In the present study, we aimed to describe patterns of SB in office workers with long-term access to sit-stand workstations and to determine the extent to which these patterns vary between days and workers. METHODS: SB was objectively monitored using thigh-worn accelerometers for a full week in 24 office workers who had been equipped with a sit-stand workstation for at least 10 months. A comprehensive set of variables describing SB was calculated for each workday and worker, and distributions of these variables between days and workers were examined. RESULTS: On average, workers spent 68% work time sitting [standard deviation (SD) between workers and between days (within worker): 10.4 and 18.2%]; workers changed from sitting to standing/walking 3.2 times per hour (SDs 0.6 and 1.2 h-1); with bouts of sitting being 14.9 min long (SDs 4.2 and 8.5 min). About one-third of the workers spent >75% of their workday sitting. Between-workers variability was significantly different from zero only for percent work time sitting, while between-days (within-worker) variability was substantial for all SB variables. CONCLUSIONS: Office workers accustomed to using sit-stand workstations showed homogeneous patterns of SB when averaged across several days, except for percent work time seated. However, SB differed substantially between days for any individual worker. The finding that many workers were extensively sedentary suggests that just access to sit-stand workstations may not be a sufficient remedy against SB; additional personalized interventions reinforcing use may be needed. To this end, differences in SB between days should be acknowledged as a potentially valuable source of variation.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Umeå university.

Objectives The aim was to assess the association between occupational biomechanical exposure and the occurrence of radial nerve entrapment (RNE) in construction workers over a 13-year follow-up period. Methods A cohort of 229 707 male construction workers who participated in a national occupational health surveillance programme (1971-1993) was examined prospectively (2001-2013) for RNE. Height, weight, age, smoking status and job title (construction trade) were obtained on health examination. RNE case status was defined by surgical release of RNE, with data from the Swedish national registry for out-patient surgery records. A job exposure matrix was developed, and biomechanical exposure estimates were assigned according to job title. Highly correlated exposures were summed into biomechanical exposure scores. Negative binomial models were used to estimate the relative risks (RR) (incidence rate ratios) of RNE surgical release for the biomechanical factors and exposure sum scores. Predicted incidence was assessed for each exposure score modelled as a continuous variable to assess exposure-response relationships. Results The total incidence rate of surgically treated RNE over the 13-year observation period was 3.53 cases per 100 000 person-years. There were 92 cases with occupational information. Increased risk for RNE was seen in workers with elevated hand-grip forces (RR=1.79, 95% CI 0.97 to 3.28) and exposure to hand-arm vibration (RR=1.47, 95% CI 1.08 to 2.00). Conclusions Occupational exposure to forceful handgrip work and vibration increased the risk for surgical treatment of RNE.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Research suggests an association between motor variability (MV) during repetitive work and work-related musculoskeletal disorders (MSDs). However, whether MV is a consistent individual trait, even across working conditions or tasks, remains unknown. This study assessed whether individual MV traits were consistent during complex work performed under different temporal conditions. Fifteen women performed cyclic assembly under four conditions differing in pace and organisation (line-type, batch-type). MV of trapezius muscle activity and upper arm elevation was quantified and partitioned into variance components. For all MV metrics, a non-zero between-subjects variance was found, indicating consistent individual MV traits across conditions. Variance between subjects was higher for electromyography (EMG) MV metrics compared with kinematic metrics. Our results showed individuals exhibited consistent MV traits across working conditions differing in pace and production process. Further research is needed to understand whether MV is an individual predictive factor for MSD onset or progression.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology.

Hallman, David

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Keus van de Poll, Marijke

University of Gävle, Faculty of Engineering and Sustainable Development, Department of Building Engineering, Energy Systems and Sustainability Science, Environmental Science.

48. Association between psychosocial working conditions and perceived physical exertion among eldercare workers: a cross-sectional multilevel analysis of nursing homes, wards and workers

Januario, Leticia

et al.

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science.

Karstad, Kristina

National Research Centre for the Working Environment, Copenhagen, Dk.

Rugulies, Reiner

National Research Centre for the Working Environment, Copenhagen, Dk.

Bergström, Gunnar

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Holtermann, Andreas

National Research Centre for the Working Environment, Copenhagen, Dk.

Hallman, David

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

This cross-sectional multilevel study aims at investigating the associations between psychosocial working conditions of different workplace levels and perceived physical exertion among eldercare workers. Data were obtained from the ‘Danish Observational Study of Eldercare work and musculoskeletal disorderS’ (DOSES) study, including 536 eldercare workers, nested in 126 wards and 20 nursing homes. Psychosocial working conditions were measured by the Copenhagen Psychosocial Questionnaire (COPSOQ). The physical workload was measured with a self-administered scale (0–10) rating perceived physical exertion. Multilevel linear mixed models were used to determine associations of psychosocial conditions between nursing homes, wards, and workers with physical exertion. Most of the variance in the perceived physical exertion was explained by differences between workers (83%), but some variance was explained by wards (11%) and nursing homes (6%). Workers employed in nursing homes with low influence (p = 0.01) and poor leadership (p = 0.02), and in wards with high quantitative demands (p = 0.03), high work pace (p < 0.001), and low justice (p = 0.01) were at increased risk of reporting higher physical exertion. The strongest associations were found for low influence, low quality of leadership, and high work pace at nursing homes and ward levels. In conclusion, improving specific psychosocial working conditions at nursing home and ward levels may be of particular importance to reduce excessive physical workload in eldercare workers

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Stevens, Matthew

National Research Centre for the Working Environment.

Mathiassen, Svend Erik

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Holtermann, Andreas

National Research Centre for the Working Environment, Copenhagen, Denmark.

Karstad, Kristina

National Research Centre for the Working Environment, Copenhagen, Denmark.

Hallman, David

University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.

Theories of what determines research performance have evolved from political and economic science, amongst other disciplines. Contemporary research shows that universities have a problematic work environment characterized by bullying, insecure jobs, and dysfunctional leadership. In this study, we explore the relationship between the psycho-social work environment (PSWE) and research performance. The study consists of longitudinal data from a medical university in Sweden. PSWE was assessed by employee surveys and the outcome was register data from 8 years of bibliometrics and external funding. SEM-analyses were applied building on theoretical and empirical models. Results show that PSWE explained future research performance, with the highest impact on the quality of publications. The most important PSWE factors for good performance were fair, considerate leaders and a supportive social climate. The results suggest that improving the psycho-social work environment at the universities could be one strategy to improve research performance.